Wednesday, December 17, 2014

Health Care Agents: Not Forgotten, Not Gone

Interview with David Racer, President and Founder of DGR Communications, St. Paul, Minnesota

Dave Racer is an old friend of mine from days gone by when he helped me produce the Reece Report, a newsletter that addressed physician and managed care issues. In recent years, besides writing, editing, and publishing 10 health related health care books, he has served as a friend, representative, facilitator and conciliator for health care agents, who form the bridge between patients, businesses, and health plans. He admires health agents, and they trust him to represent the valuable services they bring to the health system

1. What is your relationship with insurance agents?

I support licensed health insurance agents through research and writing, and providing ongoing education about their profession.

They view me as a resource to find answers to healthcare reform issues, and here in Minnesota, to resolve problems with MNsure , the Minnesota health exchange (I’ve developed a good working relationship with the MNsure CEO that often cuts through bureaucratic roadblocks and triggers quick action).

The many (ten so far) healthcare-related books I’ve authored, co-authored, edited, and/or published, have helped me bring a broader understanding of reform trends to agents.

2. What do you do for health agents?

During the past two years, I’ve conducted four major surveys of agents that have translated into communicating their concerns to lawmakers and to MNsure. The survey results have also generated goodwill to promote the role of agents.

Although I am not a licensed insurance agent, I am a member of the National Association of Health Underwriters (NAHU) and serve as the Minnesota Legislative Committee Resource Director. I’ve spoken at NAHU events in more than 25 states as a keynoter and providing continuing education.

3. What is the role of health insurance agents in the American health system?

Agents are problem-solvers who provide counsel to individuals and employers seeking ways to mitigate the cost of medical care. While some are captive – able only to write coverage for a single company – many agents represent several insurance carriers. This means they are able to help a client make an informed choice about which health insurance best meets their needs, and budgets.

Agents earn commission from sales, and only get paid when they sell an insurance policy. Their compensation comes from the insurance company, not the individual. Insurance companies do not discount the premium if a person chooses to forgo working with an agent.

One of the greatest and most important benefits agents bring to the table is contributing to the formulation of public policy. What distinguishes agents is the same characteristic that distinguishes practicing physicians from others – they do their work in the context of reality, not theory. They are experts at judging human behavior and response to positive and negative incentives, and how individuals take advantage of the medical system. Lawmakers are wise to listen to agents’ counsel.

4. How do health insurance agents regard ObamaCare? Positively, negatively, or neutral.

Agents are ferociously independent people . Their opinions about ObamaCare vary widely.

A large faction understand that as it concerns individuals and employers who are already engaged in the commercial insurance marketplace, ObamaCare has fouled the waters – unnecessarily inflating insurance premiums. They see a chaotic marketplace driven by politics, not economics or even common sense.

Generally, agents seem to adapting to the new marketplace. Some look at it as an opportunity – mandated coverage and guarantee issue insurance having created a new revenue stream. Others are fighting for survival, and reluctantly play in the new market. But a good number are creating new models, like my friends at – a private insurance exchange that actually works.

5. I have the impression that agents feel neglected, even ignored, in the discussions surrounding the health exchanges. I also have the feeling that most agents believe the so-called health care navigators are not qualified to advise health plan prospects or small businesses about selecting the proper plan? Am I correct?

Think about it: Agents are insurance exchanges. They represent several companies and help clients find best value. Government insurance exchanges are competitors, not partners. Even though agent associations may say otherwise, government policymakers eschewed any real input from agents, instead paying lip service to their wise advice.

In my most recent survey of Certified MNsure agents, 56 percent said they would do all they could to keep clients away from MNsure, while an additional 26 percent said they would not re-certify. It’s turned out that fewer than 540 Minnesota agents are MNsure certified, compared with about 2,200 last January.

Agents are not opposed to working with navigators when it comes to helping low-income people find options. If ObamaCare worked correctly, navigators and agents would hand off clients to each other – working together to enroll people in appropriate plans.

But agents absolutely are opposed to unlicensed, inexperienced navigators making any recommendations to clients about commercial insurance. This is especially true in the far-more complex world of small business insurance.

6.I have read that most businesses rely on health agents before making changes in coverage for employees. Indeed, I have heard many business owners trust their health agents more than their wives.

As MNsure moved toward its launch, it spent millions on market research. Much to MNsure’s surprise – and dismay – 86 percent of Minnesota’s employers said they would not make a decision about health insurance without consulting their agent. And a similar number said they trusted their agent more than their spouses.

7. Many of the health agents in Minnesota and elsewhere are big promoters of health savings accounts, not only because they lower premiums but because workers like the ability to make their own choices and to set aside money for retirement. Do I have that right?

Minnesota has the highest rate of individuals enrolled in HSAs in the nation. Agents gave HSAs a quick and positive welcome from the start for at least two reasons:

1) They saw it as a way to save employers and employees a good deal of money by putting them in control of their healthcare purchases.

2) HSAs, combined with high deductible health plans (HDHPs), mitigated the ever-increasing premiums of HMO and PPO plans. Overall, agents embraced the idea of healthcare consumerism, placing individuals in charge of more of their healthcare decisions.

Minnesotans, however, had an advantage in that the differential between HDHP premiums and those of HMO/PPO plans was 20-60 percent or more. This reduced cost make it more possible for employers to subsidize HSAs. That premium gap has shrunk over the years, unfortunately.

8. What has been the experience in Minnesota with MNSure, a state run health exchange? Is it true that the best-selling health plan at MNsure recently had to dramatically raise premiums because they were going broke?

PreferredOne, an insurance carrier owned by three huge provider systems, sold more than 60 percent of MNsure health plans during the 2014 enrollment period. Politicians trumpeted their low premiums, “the lowest in the nation.”

Turns out, PreferredOne’s rates were far too low, and their loss ratio far too great. They dropped off MNsure for 2015, and then announced premium increases averaging 63 percent. Agents certainly hope that PreferredOne can weather this storm, but blame Minnesota’s regulators for pressuring the company to reduce its 2014 rates to dangerously cheap levels.

9. How popular is ObamaCare in Minnesota, a bastion of Democrat liberalism? What is the percent of the uninsured in Minnesota, which prides itself on its progressive politics? Is the legislature Republican or Democratic? Do you see changes in the offing?

Minnesotans elected a GOP House majority during the 2014 election. They also sent all five Democratic incumbents back to Congress, and reelected Democratic Gov. Mark Dayton and other Democrats in statewide races. Oh, they also sent Sen. Al Franken back to Congress, and he was the 60th vote that allowed ObamaCare to move forward.

As much as I wish it, I’m not sure ObamaCare played much of a role in the 2014 election in Minnesota.

Our uninsured rate had hovered around nine percent for the past several years, and before that, settled in around seven percent. But the most critical factor in this is that 60 percent of the previously uninsured already qualified for government health plans (Medicaid or MinnesotaCare) but didn’t sign up.

By the summer of 2014, MNsure boasted that “they” had reduced our uninsured rate to less than five percent. Nearly 96 percent are now covered by a health plan. Considering that 86 percent of MNsure’s enrollees were now in Medicaid or MinnesotaCare plans, we can make this conclusion: After spending $155 million in tax dollars, we finally figured out how to convince low-income people to sign up – send out an army of navigators to convince them to do so.

10. How is Minnesota different from Wisconsin, the adjoining state, which seems to have embraced the policies of Governor Scott Walker by making him the winner in three recent elections?

We had a popular two-term GOP governor in Tim Pawlenty. But Pawlenty walked a safe and fine line, careful not to disrupt Minnesotans too much. In many ways, Pawlenty slowed down Minnesota’s persistent march toward socialism, but we stayed committed to an activist government.

Walker, by contrast, took aggressive action to change Wisconsin’s direction in so many ways. We feel warm toward Pawlenty, but Walker has heated up our passion and hope that even progressive states can grow up and make mature changes.

11. What is the self-image of health care agents? How do they see their future? What changes do they advocate in the health system?

Imagine walking into an employer meeting to announce that this year’s premium increase is “only 37 percent.” Agents have delivered that kind of news for many years. For 2015, in some parts of the state, agents have had to deliver group insurance premium increases greater than 100 percent.

It’s humbling to deliver news of premium increases, but incredibly fulfilling to find solutions for employers that at least mitigate some of the worst.

So agents have often felt a bit like the cousin who shows up for a family event to which he’s not been invited. Loved? Sort of. Appreciate? Marginally.

Agents have nothing to apologize for, and in fact, need to hold their heads high for finding some point of refuge for clients. I remind them that they deliver more than $900 billion a year in payments for medical care to Americans. Without agents and the private insurance industry they represent, America would have nowhere near the high quality care we used to enjoy – before ObamaCare began dissembling it.
Agents generally see the private marketplace as the right way to resolve our medical cost problem; they prefer state solutions to federal solutions; consumerism to communism.

They want to be listened to, and ought to be. No other profession understands human behavior toward healthcare and spending like agents, save physicians. Hey, why not urge them to talk with each other to find solutions that work.
Sorting Out Healthcare. Gov Deadlines

People who like this sort of thing will find this sort of thing they like.

Abraham Lincoln (1809-1865)

I’ve been sorting through all sorts of news on what sort of people are enrolling in health exchanges in this 2nd launch (November 15 to February 15).

It’s all sort of confusing, which is sort of expected, since the time of 2nd enrollment is only 3 months , occurs at the peak of the holiday season, and takes place in the midst of changing over to a new Republican dominated Congress.

The deadline for re-enrollment was supposed to be December 15, but by December 5, only 720,000 had enrolled. Due to that slow start and the sudden surge just before December 15, a number of states – Idaho, New York, Maryland, Massachusetts , Minnesota, Rhode Island , and Washington – have delayed the December 15 deadline to December 19 to December 23.

The federal and state governments and the insurance industry agree on the delays for different reasons. The federal and state exchanges want to maximize credibility to offset GOP attacks on ObamaCare, and the insurers want to gain the greatest market share of the new exchange plans. So a new found symbiosis is taking place between government and private sectors.

The government is saying things are going swimmingly with 2.5 million enrollments, well on the path to expand the enrollment base from 6.7 million to 9.1 million. But critics say government is ill-prepared for the enrollment surge, as consumers endure longer waiting times as they try to unlock last year’s accounts , reset passwords, and prove their eligibility, both for exchange plans and Medicaid.

It’s all sort of confounding, with different key strokes for different folks and different sorts of information flowing from federal and state exchanges. About half those signing up are new customers. The other half are renewing customers. The old customers who miss old or new deadlines will automatically be enrolled by the January 1 deadline, and open enrollment will continue until the February 15 deadline.

Meanwhile depending on your state of enrollment, there will be soft and hard deadlines. But not to worry. You can always trust the government – sort of.

Tuesday, December 16, 2014

Middle Class Families Squeezed

It is important to note that health-care cost increases of 24.2% and 42.1% for health insurance from 2007-2013 overlap the Affordable Care Act’s passage and performance since 2010. The law, as we all know, promised to have the opposite effect on health costs and health insurance.

Richard L. Reece, MD, Old Saybrook, Conn, Letter to the Editor, December 16, Wall Street Journal

As you can see, I made it to the Letters to the Editor section of the Wall Street Journal, America’s most widely daily circulated newspaper at 2.3 million, followed by the New York Times at 2.2 million, and USA Today at 1.2 million.

I read all 3, but I concentrate on the Wall Street Journal because it concentrates on the effect of ObamaCare on the economy, which it believes to be negative. The Times is more ideological. It focuses on how ObamaCare helps the uninsured. USAToday treads more neutral middle ground.

Since 2009, under the Obama administration the economy has grown an average of 2%, versus 4 to 5% in previous recession recoveries under Presidents Reagan and Clinton.

When Obama assumed office, 85% of Americans were satisfied with the health system. Today that percentage is much lower. At least 59% oppose ObamaCare and 54% support its repeal. Opposition of ObamaCare and dissatisfaction with the economy both contributed to the recent midterm election results.

Election results reflected a middle class revolt, largely of the working class, hungry for jobs and opportunity, against Obama economic policies.

Republicans will have to prove they can put together bipartisan policies that grow the economy while containing health costs for the middle class and expanding access to care for all.

President Obama has misread American culture. The majority believe government is best that governs least , that provides equal opportunity but not necessarily equal results for all, and that delivers on its promises of lower health costs for families while allowing them to pick their health plans while keeping their doctors and hospitals. You can only squeeze the middle class health care and economic lemon so much before it runs dry. When you're in a political bind, sometimes you throw out the covering rind.
Can GOP Fix ObamaCare?

What’s done is done and cannot be undone.


I belong to the school that says things will never be the same after ObamaCare.

What’s done is done and cannot be undone completely. No, but it can be partially redone.

As the New Year approaches and the GOP takes control of Congress, there’s a lot of talk of how Republicans might undo ObamaCare.

Much of this talk centers around the Supreme Court decision due in June on whether the health law’s wording allowed the Obama administration to offer subsidies through 36 federal health exchanges. What happens if the Court negates these federal subsidies?
What happens if these subsidies continue in state exchanges?

One, the federal government could talk back subsidies from some 7 million people (the exact number will not be known until after the February 15, 2015 deadline of the second launch ends). This seems political untenable, unstable, and unsustainable) since it would result in skyrocketing premiums, the death spiral of health insurance markets, and a deafening political uproar about unfairness between liberal and conservative states. Blue states – like California, New York, Maryland, and Connecticut – which have their own exchanges could continue to offer subsidies.

Two, the Court could simply edit the law to include all states offering exchanges, whether federal or state run, causing the law to remain essentially intact.

Three, the GOP could pass alternative legislature that would repeal ObamaCare and end subsidies for all and replace the subsidies with tax credits for all and allowing buying of plans across state lines, presumably lowering premiums through competition, or lowering costs by permitting patients the freedom to choose their own plans, free of comprehensive cost-raising regulations, coupled with such market-based changes as health savings accounts and catastrophic ceilings on costs.

Four, the GOP could repeal ObamaCare, make changes such as changing the definition of full time work from 30 to 40 hours, ending the excise tax on medical innovation companies, and ending penalties associated with the individual and employer mandate.

Whatever happens, the GOP must get its act together and put together a coherent, unified, pragmatic alternative to ObamaCare that makes sense to the American people and does not destabilize or cancel existing health plans, while at the same time, lowering premiums, deductibles and co-payments; decreasing the number of uninsured. And Republicans must do so with the knowledge they cannot redo the entire system and undo what has already been done. They can redo without completely undoing.

Monday, December 15, 2014

Castle Connolly Private Health Partnership and Concierge Medicine

For over ten years, I have served on the medical advisory board of Castle Connolly Ltd, a medical company devoted to identifying America’s top doctors and to empowering, protecting, and optimizing the physician/doctor relationship.

Castle Connolly is now expanding its business by entering the arena of concierge medicine, both in the United States and abroad. There is a yearning here and elsewhere for private physician-patient relationships outside the realm of government.

For more information on how to join the concierge movement, visit or call 1-212-367-1950.

Here is the concierge private health partnership as envisioned by Castle-Connolly.

The CCPHP program offers a strong value proposition for both physician practices and patients. Key benefits include:

-- Conversion sales & marketing expertise with demonstrated success in both retaining patients and improving their satisfaction

--Increased emphasis on important aspects of patient care such as prevention, wellness, and chronic disease management

-- Longer and unhurried patient visits

-- Outstanding patient experience of care

-- Expanded collaboration between physicians and patients

Access to a proprietary health coaching model that provides staff with training, content, and ongoing support from national experts

These features lead to stronger physician-patient relationships and more desirable healthcare outcomes - a true win/win for patients and physicians.

Increased emphasis on important aspects of patient care such as prevention, wellness, and chronic disease management

-- Longer and unhurried patient visits

-- Outstanding patient experience of care

-- Expanded collaboration between physicians and patients

--Access to a proprietary health coaching model that provides staff with training, content, and ongoing support from national experts

These features lead to stronger physician-patient relationships and more desirable healthcare outcomes - a true win/win for patients and physicians.
Interview with Health Care Swami

Take up one idea. Make that idea your life - think of it, dream of it, and live on that idea.

Swami Vivekandanda

What do you see almighty swami?

I see a new health care economy,

I see sliced institute salami,

I see institutes of joints and knees,

I see institutes for cash only fees,

I see institutes for cancer only,

I see institutes for heart mainly,

I see institutes for arteriosclerosis,

I see institutes for cerebral thrombosis,

I see institutes for walk-in surgery,

I see institutes for neurosurgery,

I see institutes for ophthalmology,

I see institutes for oncology,

I see institutes for diabetes,

I see institutes for obesity,

I see institutes for the spinal,

I see institutes for the renal,

I see institutes for the fertile,

I see institutes for the infertile.

I see institutes for chemically addicted,

I see institutes for genetically afflicted,

I see institutes for primary care,

I see institutes for diseases rare,

I see institutes for quiet meditation,

I see institutes for bad medications,

Everywhere my eye can see and look

I see an institute for another nook.

Everywhere I look across the health care landscape

I see an institute with a special mission and mandate.